Understanding Lethargy: What It Means When You’re Tired All the Time

illustration of a lady sitting at a desk looking tired and worried

As a medical term, lethargy is a subjective feeling described by a patient. It can assume different forms and be described variously like: “Doctor nowadays, I am tired all the time.” Or, “I feel so tired in the morning in spite of sleeping sufficiently.” Possibly also: “Doctor, I feel so tired even from doing simple tasks.” Though being tired can only be felt by the sufferer, there is hope in finding out the real reasons behind unexplained lethargy (low energy). This is because fatigue can be objectively assessed by a medical practitioner.

Though being tired all the time can be an indicator of grave disease, it is often easily dismissed as harmless. This mislabeling is in part attributable as tiredness is widely considered as part of modern day, everyday adult existence. Consistency in the vagueness of what one means when they say they are tired makes it all the worse.

The closest one can get in describing tiredness medically is a feeling of a decline in energy levels: A global tiredness, a decrease in comfort in performing the mundane acts of daily living. When tiredness is prolonged and limiting, it is termed fatigue.

You might hear someone say…..

The following to mean they are feeling tired all the time: Kuchapa (Sheng, Kenya), Kubeat (Sheng, Kenya), Sina moods (Sheng, Kenya), uchovu (Swahili),

Medically, What is Fatigue?

Dr. Steven Targum and Dr. Fava Maurizio in their paper on Fatigue as a Residual Symptom of Depression published in the journal Innovations in Clinical Neuroscience offer:

Broadly defined, symptoms of fatigue can affect physical, cognitive, and emotional function, impair school and work performance, disturb social and family relationships, and increase healthcare utilization. Nonetheless, even for medical practitioners with keen clinical acumen, it is easy to pay little attention to a complaint from a patient  about being tired all the time by attributing it to be part of the constellation of symptoms of common disease.

Dr. Steven Targum & Dr. Fava Maurizio

This difficult case of Schnitzler syndrome chronicled in the New York Times reveals the folly in such an approach. The danger in pedestrian dismissal or falling victim to lies in failing to promptly identify and subsequently manage common but life threatening medical conditions.

Patients are their own best doctors

First, it is worth noting that this article aims at informing you the patient as a partner in patient centered care. Our overall aim is to  increase the overall value that you derive from your doctor’s visit. We acknowledge that individuals often fail to grasp their primary role in managing their health.

In view of this, it is worth reiterating the first rule of clinical medicine: “Patients are their own best doctors.” This is so, as patients are the ones best placed to recognize any changes to their well-being, an important initial step in management of disease as it is the heart of good health seeking behavior.

The doctor’s role, if only, is to employ their expertise in helping the patient understand their condition. It is in reveling in such wisdom that we penned this piece intending to foster this patient centered driven collaborative approach that defines value in 21st century healthcare.

The disease spectrum in a case of lethargy can range from simple anemic condition to more complicated cases such as heart failure. The following are some of the commoner health conditions associated with the feeling of being tired most of the time.

1. Sleep Problems

Yes, the globalized 21st century is a demanding world. Yes, we understand that you are a focused, ambitious, self driven and hard working individual. Bedbugs too may reduce the quality of sleep and result in fatigue. But please do get your hours safely under the belt at night. 6-8hrs is what is recommended in most texts. Besides a rested mind is more efficient, less prone to accidents and its even claimed that the slumber holds some magical beauty powers.

Lack of sleep not only make you fatigued but also predispose one to the other common but more dangerous condition to be discussed next. The lack of sleep deprives one of physical, cognitive and emotional state needed to be functional persons in everyday life. This may lead to work and social problems and therefore compound other life stressors leading to depression.

2.The Unhappy Triad of Mental Disease, Being Tired All The Time & Lack of Sleep

One of the tell-tale signs of depression is a complaint of unusual tiredness. The reason why one might feel tired all the time in depression is compound. First, the patient usually also complains of a disturbed sleep patterns whose hallmark is insomnia or the lack of sleep. Additionally, activities that were routine such as going to work are now considered to be herculean tasks as apathy sets in contributing to the vicious cycle of disturbed sleep patterns that may conversely manifest as early morning wakefulness.

Care though should be taken as it is easy to misdiagnose innocuous conditions such as simple burn out  fatigue as depression and vice-versa. This mistake is common and leads to inadvertent use and abuse of over the counter sleeping pills such as Ambien.


However, depression is  the commonest psychiatric condition in this high pressure, fast paced age of wanton self indulgence. Depression should therefore be readily identified and managed accordingly by a qualified mental health professional. This is because depression is one of the leading causes of suicide not only in teenagers but also in the adult population.

Appropriate health seeking is encouraged on the back of sustained unfamiliar notable tiredness in a loved one. Besides depression, General Anxiety Disorder (GAD) might also make people feel tired all the time. GAD is state of constant anxiety which makes it difficult for one to concentrate and manifests as myriad of both physical and mental symptoms.

3. Blood Diseases

The hematological system concerns itself with blood components and blood forming organs such as the bone marrow. Red blood cells, biconcave shaped cells that form part of the cellular components of blood, are important in the transfer of oxygen and carbon dioxide to and from body tissues.

When the mass of these red blood cells or the heme pigment which it carries (hemoglobin) reduces to a point below the lower cut off for a particular age, sex and race; the individual is said to be suffering from anemia.

One of the cardinal symptoms of anemia is feeling tired all the time. When this fatigue is accompanied by other symptoms such as awareness of the heartbeat (palpitations) or frequent headaches the diagnosis of anemia becomes more likely.

Quick Facts About Anemia

The cause of anemia varies across age groups as evident in increased prevalence of anemia among women of the reproductive health group as a direct consequence of blood loss through cyclical menstrual bleeds
This condition which can be reliably picked by examination of the tongue, palms, inner cheek and eyes for paleness (palor)
Once the health provider confirms palor, it should be thoroughly be investigated via a detailed history querying various aspects ranging from nutrition to lifestyle habits such as smoking
This is then followed by a thorough physical examination so as to elicit the physical signs of disease and concluded by performing a battery of both radiological and laboratory tests such as hematological, microbial, endocrine and tumor maker detection as the causes of anemia are varied
Anemia is common finding in most chronic diseases like various forms of malignant cancers , HIV infection and tuberculosis. Quite often, anemia acts as a surrogate marker for underlying serious pathological processes.

4. Diseases of the Heart (Cardiovascular System)

The cardiovascular system refers to the conduits of blood namely; the heart and blood vessels. According to the  widely used New York Heart Association (NYHA) criteria for grading heart failure, varying degrees of tiredness on doing normal activities are indicative of the degree of failure of the heart’s pumping mechanism.

Severe forms of heart failure are indicated by breathlessness (dysponea) at rest. However, milder forms of heart disease present with dysponea on activity such as walking. The health of the cardiovascular system is of particular interest in investigating fatigue. This is especially the case for diabetic, hypertensive or in individuals who carry other risks of developing cardiovascular disease.

The cardiovascular system is also actively assessed where peripheral artery disease is suspected such as in young male chronic smokers (Berger’s disease). This might be useful line of query when investigating more ‘regional’ causes of feeling tired all the time like lower limb tiredness.

5. Chronic Fatigue syndrome

Isn’t it ironic that a sector that can be said to best exemplify feminist ethics, health care, stands accused of being insensitive to the  women? If diseases were created for a purpose, CFS was created to test this paradox. Diagnosis of a condition as fleeting as chronic fatigue syndrome requires every bit of  an approach grounded in feminist ethics.

Incidentally, chronic fatigue syndrome majorly afflicts women. A diagnosis arrived by exclusion, it thought that even this epidemiological pattern that suggests a sex preference maybe a skewed observation on account of better health seeking behavior from women.

What is chronic fatigue syndrome (CFS)?

Mayo’s Clinic succinctly defines CFS or myalgic encephalomyelitis (ME) or systemic exertion intolerance disease (SEID). Mayo Clinic defines CFS as a complicated disorder characterized by extreme fatigue. More importantly, the fatigue in CFS can’t be explained by any underlying medical condition. The fatigue may worsen with physical or mental activity, but doesn’t improve with rest.

Tired All The Time? A New Approach To Treating Fatigue

While the tremors for agitation for cognizance of feminist perspectives in politics, Hollywood, entrepreneurship and other societal realms can be felt, feminist approaches to health care remain mere fine ripples.

Feminist model of practice is grounded in feminist theories that are applicable to the health and health care of women. The goal of this model is to change how health care is delivered to individual women, but also to seek social transformation. Four major themes recur in this model: symmetry in provider-patient relationships, access to information, shared decision-making, and social change

Medical professionals investigating if their clients are suffering from need to adopt a different mentality. This paradigm shift should be adopted by all professionals handling patients presenting with any type of fatigue. The causes of fatigue are varied as it is a common presenting symptom in the ERs and doctor’s rooms.

Linda C. Andrist in “A Feminist Model For Women’s Health Care”

Some of the responsibility in treating fatigue lies with the patient seeking care promptly. This an endpoint that we can only desire if actionable information reaches the general public for its consumption and action.

Besides, health systems should be also designed in a way that it nudges those who need to seek health care from it, to seek care. Otherwise, it is tragically easy to ignore a symptom that could be the only audible tick of an underlying health “bomb”.

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